A consistent sleep routine is helpful for treating and / or preventing the most common childhood sleep disorders. Routines that integrate relaxing pre-sleep activities and an environment free of over stimulating or distracting activities are best for your child.
Spending time with your child before bed each night is a critical part of the bedtime ritual. Do not substitute television or videos for personal time with your child each night. Positive parent-child interactions before bed help your child to calm and feel comfortable with the transition to bed.
For children with a sleep-onset association problem, a bedtime routine that promotes the child's ability to fall asleep independently is important. Teach your child to fall asleep independently at all sleep intervals (including naps).
- Set up an environment (sleep associations) at bedtime that does not require a response from you (e.g., play music, put on a nightlight, provide comfort items).
- Avoid having your child fall asleep in your arms or while you are rocking her. Place her in her bed before she falls asleep.
- For the young child (that is still napping) it may be easiest to start the relearning process at night.
- Your child is expected to cry at first during this process.
- You are not abandoning your child by intentionally ignoring mild distress for set periods of time. When you allow your child to experience increasingly longer periods alone in bed followed by brief encouragement and reassurance, your child can learn to fall asleep without your presence.
- Place your awake or drowsy child in their bed after you have completed a calming and quiet bedtime routine.
- Say goodnight and leave the room. You may keep the door open to allow some dim light into the room or use a nightlight.
- If your child begins to cry and is still crying after a few minutes, return to the room and provide brief reassurance with words or light physical touch (placing hand on back or belly). Do not pick up your child, turn on the lights, or respond to requests (e.g., another bedtime story). Do not stay in the room longer than one or two minutes. Repeat this process, extending the time that you give your child to fall asleep independently (e.g., 2 minutes; then 5 minutes; then 10 minutes; then 15 minutes). Increase the time that you are out of the room in increments of five minutes to help your child gradually become more comfortable being alone in her bed.
- On subsequent nights increase the intervals of time that you allow your child to self-sooth. For example on the second night start at 5 minutes and on the third night start at 10 minutes.
- The first few nights are going to be the most difficult for you and your child as you learn this new routine. The time that you spend away from your child when he is upset can be very difficult for you. However, it is important to keep in mind that you are teaching him to learn a very important developmental skill (falling asleep independently).
If you are able to use this approach consistently on consecutive nights, you are likely to see results in five to 10 days.
If your child becomes sick or there is some other event that interferes with this process, you will likely have to start the process again.
If you feel you have been consistent with this approach for a two-week period and you are not seeing results, you should consider having your child evaluated for another underlying sleep disorder.
For a child with nighttime feeding problems it is important to gradually wean your child from this habit by reducing access to food / drink. This can be accomplished by reducing the frequency of nighttime feedings (i.e., increase the interval of time between feedings). It may help to set defined time intervals to offer your child a bottle (e.g., every two hours) and slowly increase the interval periodically until you are no longer offering the bottle at night. If your child wakes up and signals hunger before the time you have set for access to food / drink, provide brief reassurance and give them an opportunity to fall back asleep without access to food (see above for guidelines on helping your child to self-soothe and fall asleep independently).
For a child with limit-setting problems at bedtime it is important to have a consistent bedtime routine as well as very clearly defined behavioral limits for bedtime. Parents should focus on having a relaxing pre-sleep ritual each night, however, the transition to bed may require a more "matter of fact" approach. A firm and consistent response to your child's delay at bedtime will prevent you from inadvertently reinforcing your child's "delay behaviors." Limit-setting during the day and night are important. It may be helpful to establish a behavioral reinforcement system that provides behavioral incentives for your child's cooperation with bedtime and staying in bed through the night.